Assisted conception, is a general term to describe all the methods used to help a woman achieve a pregnancy when she is having difficulty conceiving. The world’s first test-tube baby Louise Brown, was born in the UK in 1978. Her birth offered hope to infertile couples across the world. Since then thousands of couples have made use of in vitro fertilisation (IVF) and other assisted conception techniques. The success rates of these treatments continue to improve with advances in technology. IVF treatment is available all over the world, the quality and value you get vary from one centre to another.
Today, assisted conception treatments are tailored to individual patients’ unique conditions. These procedures are usually paired with more conventional therapies such as fertility drugs to increase success rates. On average one in five couples who use assisted conception techniques gives birth to a baby or in some cases twins or even triplets depending on the technique.
The three most common reasons for assisted conception are that:
• the woman’s ovaries are not producing eggs,
• her fallopian tubes (tubes from the uterus to the ovary) are damaged or,
• that the man’s sperm are too few or unhealthy. These reasons account for about 90 per cent of all cases. Treatments are available for both male and female fertility problems.
Treatment options could vary from simple use of Fertility drugs, then graduating to artificial insemination, and if this fails, there is the more advanced option of assisted conception techniques.
In looking for a baby, there are other numbers to consider in your quest to have a baby. Increased use of assisted reproduction technologies has contributed to an increase in multiple births. And while many couples may welcome a set of twins, the prospect of triplets, quadruplets or even quintuplets can be daunting to say the least. Some physicians implant three to five embryos to maximise the chance of success. As evidenced by the much-publicised mother that gave birth to eight babies post IVF treatment, Octomom, , some fertility specialists have been known to go to greater lengths. As a result, worldwide, 45% of IVF babies are high-order pregnancies (three or more fetuses). Multiple pregnancies carry with them associated risks including a higher incidence of mortality, birth defects, premature delivery and low birth weight.
The incidence of multiple births come about mainly because of the effect of the fertility drugs used to cause super ovulation of the ovaries. Ovulation induction is also the first stage of preparation for in-vitro fertilisation (IVF), which is the treatment needed by most women whose tubes are damaged.
Three hormones are used:
• one to suppress the ovaries.
• one to stimulate several eggs to develop simultaneously and
• one to ripen the eggs.
We can see here , that there is the possibility of the numerous eggs produced, by induced effect on the ovaries, can further on lead to the incidence of multiple births.
What then are the possibilities of multiple pregnancy ?
Multiple gestations, especially triplet and higher order pregnancy, is not the desired consequence of assisted conception technologies since it increases the risk of complications for both mother and baby. The goal of any reproductive technology is the birth of a single healthy child and the conception of twins or higher is considered a complication. Ovulation induction increases the chances of having a multiple pregnancy (twins, triplets etc). The rate of multiple pregnancy is increased compared to spontaneous conception. Unlike natural conception where the chance of having a multiple birth is relatively low (1 in every 65 pregnancies), assisted conception brings with it a high chance of a multiple birth (roughly one in four IVF deliveries is of twins i.e. the chance of twins is approximately 20 to 25 per cent.).
Although most twins are born healthy, the chance of complications during pregnancy and delivery is much greater than with a singleton. The high incidence of multiple births following IVF is largely due to the super ovulation, and the fact that more than one embryo is usually transferred to the woman’s womb during an IVF cycle. This is done to increase the chances of conception.
Multiple pregnancy is the most common adverse outcome of assisted reproduction technologies (ART) and reflects the standard practice of replacing multiple embryos in the uterus during in vitro fertilisation (IVF) treatment.
A study carried out in the UK, showed the response to concerns about the high numbers of twin and triplet pregnancies arising from ART. It was proposed that One child at a time identified the significant risks to the health of the offspring that result from twin and triplet gestation compared with singleton pregnancies.
The risks are higher at all stages of pregnancy and include
• gestational diabetes and pre-eclampsia,
• impaired fetal growth and stillbirth, and
• problems during labour ,
• increased need for elective and emergency caesarean section.
Most significantly in terms of morbidity, mortality and cost, twin pregnancy carries a five- to six-fold increase in the risk of preterm birth. Preterm birth is often followed by a prolonged stay in neonatal ntensive care. This leads in turn to an increased risk of long-term mental and physical handicap Including cerebral palsy, mental disability, long-term learning difficulties and chronic lung disease.
Some clinics in our own locality, in Nigeria, in order to strive to maintain a high position in the success rate , and desperate couples, whose desire to maximise the chance of pregnancy far outweighs the fear of adverse outcomes of a treatment they believe may be an apparently ideal outcome and may allow them to achieve a family more quickly and cheaply if they conceive a twin pregnancy. It remains the case that the pregnancy rate is higher following replacement of two embryos rather than one embryo, and this single fact is a powerful driver. Couples desperate to have a child may fail, either consciously or unconsciously, to consider fully the devastating consequences of having one or more children affected by cerebral palsy, neuro developmental delay or other serious long-term medical conditions.
Another consideration is the financial status of the patients. Those that are barely able to afford to pay for this expensive procedures, would want as many embryos as possible, put back. Those who have to pay often large sums from their own resources unsurprisingly seek to complete their family as cheaply as possible.
What then can be done ? The patient has the right to discuss with their doctor, the need to work towards the possibility of a singleton pregnancy.
Incidentally, IVF can actually be used to achieve this by looking at the following procedures, all made possible by the selected laboratory technique employed in your treatment procedure. :
Employing IVF to REDUCE the chance for a multiple birth
Ironically, IVF – the very procedure that has played a part in the rise of multiple births – is playing an important new role in reducing them, thanks to innovative technology and techniques:
• Blastocyst Culture and Transfer – Clinicians grow the embryos in a nutrient-rich media for five days instead of the conventional three. This enables them to select the healthiest, promising embryos for implantation. Fewer need to be implanted, and the remainder can be frozen for future use, if needed.
• Elective Single Embryo Transfer (eSET) – Studies show that implanting multiple embryos in women under 35 doesn’t improve the pregnancy rate, it just increases the chance of a multiple birth. With eSET, a single embryo, usually a blastocyst, is transferred. In some countries , they recommend a single embryo in women under 35 – two in those with an unfavorable prognosis.
• Preimplantation Genetic Diagnosis (PGD) – Microscopic evaluation of early-stage (3-day) embryos identify those with the best development characteristics.
• Comparative Genomic Hybridisation (CGH) – This new screening technique examines the 5-day blastocyst, allowing analysis of all 23 pairs of chromosomes to identify those with abnormalities thought to be responsible for implantation failure.
There is no limit to how far or well you can go with your treatment procedure. the bottom line is for you to have in mind that the risks far outweighs the desire to have multiple births from your treatment procedure.